This document discusses improving pain management through clinical simulation training for resident physicians. It provides background on pain, current pain management methods, and tools for assessing pain. Clinical simulation allows residents to practice assessing pain and determining appropriate opioid medication dosages through interactions with standardized patients. A simulation-based training program aimed to increase resident confidence and improve skills in areas like using pain scales, considering addiction risk, and writing proper medication orders. The training resulted in residents feeling more comfortable making dosage decisions and more frequently using proper opioid conversions.
Pain assessment in ED an evidence-based updatekellyam18
This presentation delivered at the International Conference on Emergency Medicine in Dublin describes different approaches to assessing pain in emergency department patients. It summarises the evidence supporting the various approaches and makes recommendations for practice.
Pain assessment in ED an evidence-based updatekellyam18
This presentation delivered at the International Conference on Emergency Medicine in Dublin describes different approaches to assessing pain in emergency department patients. It summarises the evidence supporting the various approaches and makes recommendations for practice.
Geriatric Population. Pain and Palliative Care for the Older (Geriatric) AdultMichelle Peck
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of Geriatric Populations, Pain and Palliative Care for the Older (Geriatric) Adult, you will experience: the assessment of pain; pain management strategies; and learn more about Palliative Care services.
As a health care consumer it is important to recognize and be aware of the quality of life benefits of good pain and symptom control. This begins with a good assessment of the factors contributing to the pain. Pain is a multifaceted experience. There are many barriers to achieving effective pain control in the elderly (geriatric population). Health care providers need to be aware of personal biases surrounding pain for proper pain management. There are also many health care provider misconceptions regarding Palliative Care especially in the geriatric population.
To enrich your geriatric understanding, at the end of this slide deck we discuss Palliative Care: the relief you need when you are experiencing serious medical illness.
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Beyond the Opioid Epidemic - Patient Centered Approaches to Pain ManagementMichael Changaris
This presentation explores pain neuroscience and developing high quality pain management. Even when the opiate epidemic is no longer taking lives people will have chronic pain and deserve effective patient centered pain care.
Learning Objectives
1. Identify strategies for Clinical Reasoning Strategies.
2. Identify the RIME Framework for Clinical Competency.
3. Identify how to facilitate Bedside Teaching (according to Cox Model).
Geriatric Population. Pain and Palliative Care for the Older (Geriatric) AdultMichelle Peck
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
During your journey through this slide deck of Geriatric Populations, Pain and Palliative Care for the Older (Geriatric) Adult, you will experience: the assessment of pain; pain management strategies; and learn more about Palliative Care services.
As a health care consumer it is important to recognize and be aware of the quality of life benefits of good pain and symptom control. This begins with a good assessment of the factors contributing to the pain. Pain is a multifaceted experience. There are many barriers to achieving effective pain control in the elderly (geriatric population). Health care providers need to be aware of personal biases surrounding pain for proper pain management. There are also many health care provider misconceptions regarding Palliative Care especially in the geriatric population.
To enrich your geriatric understanding, at the end of this slide deck we discuss Palliative Care: the relief you need when you are experiencing serious medical illness.
Learn it-Live it-Love it-Your path for a more informed life!
Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher
Beyond the Opioid Epidemic - Patient Centered Approaches to Pain ManagementMichael Changaris
This presentation explores pain neuroscience and developing high quality pain management. Even when the opiate epidemic is no longer taking lives people will have chronic pain and deserve effective patient centered pain care.
Learning Objectives
1. Identify strategies for Clinical Reasoning Strategies.
2. Identify the RIME Framework for Clinical Competency.
3. Identify how to facilitate Bedside Teaching (according to Cox Model).
this topic explains the nature of pain, signs and symptoms of pain, different types of pain, factors influencing pain, assessment of pain and pharmacological and non pharmacological management of pain.
Is the ability to access, assess and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
Patient Safety and Professional Nursing Practice C.docxkarlhennesey
Patient Safety and
Professional
Nursing Practice
Chapter 8
Patient Safety
• Ensures that nursing practice is safe, effective,
efficient, equitable, timely, and patient-centered
(ANA)
• Minimization of risk of harm to patients and
providers through both system effectiveness and
individual performance (QSEN & NOF)
To Err is Human: Building a Safer
Health System (IOM, 2000)
• At least 44,000 and possibly up to 98,000
people die each year as the result of
preventable harm
• Cause of the errors is defective system
processes that either lead people to make
mistakes or fail to stop them from making a
mistake, not the recklessness of individual
providers
Error
• Error is the failure of a planned action to be
completed as intended, or the use of a wrong
plan to achieve an aim with the goal of
preventing, recognizing, and mitigating harm
• Common errors include drug events and
improper transfusions, surgical injuries and
wrong-site surgeries, suicides, restraint-related
injuries or death, falls, burns, pressure ulcers,
and mistaken patient identities (IOM, 2000)
Event Analysis
• Individual approach or system approach
– Culture of blame
– Culture of safety
– Just culture
• Root-cause analysis
• TERCAP
• Reason’s Adverse Event Trajectory
Classification of Error
• Type of error
– Communication
– Patient management
– Clinical performance
• Where the error occurs
– Latent failure and active failure
– Organizational system failures and system process
or technical failure
Human Factor Errors
• Skill-based
– Deviation in the pattern of a routine activity such
as an interruption
• Knowledge-based
• Rule-based
– Conscious decision by the nurse to “workaround”
or take a shortcut, so the system defense
mechanisms are bypassed, thereby increasing risk
of harm to patient
To Err is Human: Building A Safer
Health System (IOM, 2000) (1 of 2)
• User-centered designs with functions that make
it hard or impossible to do the wrong thing
• Avoidance of reliance on memory by
standardizing and simplifying procedures
• Attending to work safety by addressing work
hours, workloads, and staffing ratios
• Avoidance of reliance on vigilance by using
alarms and checklists
To Err is Human: Building A Safer
Health System (IOM, 2000) (2 of 2)
• Training programs for interprofessional teams
• Involving patients in their care; anticipation of
the unexpected during organizational changes
• Design for recovery from errors
• Improvement of access to accurate, timely
information such as the use of decision-making
tools at the point of care
Crossing the Quality Chasm: A New
Health System for the 21st Century
(IOM, 2000)
• STEEEP
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered
• 10 rules for redesign
– Rule #6: Safety is a
system property
Keeping Patients Safe: Transforming the
Work Environment of Nurses
(IOM, 2004) ...
Patient Safety and Professional Nursing Practice C.docxssuser562afc1
Patient Safety and
Professional
Nursing Practice
Chapter 8
Patient Safety
• Ensures that nursing practice is safe, effective,
efficient, equitable, timely, and patient-centered
(ANA)
• Minimization of risk of harm to patients and
providers through both system effectiveness and
individual performance (QSEN & NOF)
To Err is Human: Building a Safer
Health System (IOM, 2000)
• At least 44,000 and possibly up to 98,000
people die each year as the result of
preventable harm
• Cause of the errors is defective system
processes that either lead people to make
mistakes or fail to stop them from making a
mistake, not the recklessness of individual
providers
Error
• Error is the failure of a planned action to be
completed as intended, or the use of a wrong
plan to achieve an aim with the goal of
preventing, recognizing, and mitigating harm
• Common errors include drug events and
improper transfusions, surgical injuries and
wrong-site surgeries, suicides, restraint-related
injuries or death, falls, burns, pressure ulcers,
and mistaken patient identities (IOM, 2000)
Event Analysis
• Individual approach or system approach
– Culture of blame
– Culture of safety
– Just culture
• Root-cause analysis
• TERCAP
• Reason’s Adverse Event Trajectory
Classification of Error
• Type of error
– Communication
– Patient management
– Clinical performance
• Where the error occurs
– Latent failure and active failure
– Organizational system failures and system process
or technical failure
Human Factor Errors
• Skill-based
– Deviation in the pattern of a routine activity such
as an interruption
• Knowledge-based
• Rule-based
– Conscious decision by the nurse to “workaround”
or take a shortcut, so the system defense
mechanisms are bypassed, thereby increasing risk
of harm to patient
To Err is Human: Building A Safer
Health System (IOM, 2000) (1 of 2)
• User-centered designs with functions that make
it hard or impossible to do the wrong thing
• Avoidance of reliance on memory by
standardizing and simplifying procedures
• Attending to work safety by addressing work
hours, workloads, and staffing ratios
• Avoidance of reliance on vigilance by using
alarms and checklists
To Err is Human: Building A Safer
Health System (IOM, 2000) (2 of 2)
• Training programs for interprofessional teams
• Involving patients in their care; anticipation of
the unexpected during organizational changes
• Design for recovery from errors
• Improvement of access to accurate, timely
information such as the use of decision-making
tools at the point of care
Crossing the Quality Chasm: A New
Health System for the 21st Century
(IOM, 2000)
• STEEEP
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered
• 10 rules for redesign
– Rule #6: Safety is a
system property
Keeping Patients Safe: Transforming the
Work Environment of Nurses
(IOM, 2004).
Resident Performance from the Patient's View: Richard Wardrop, MD, PhD, FAAPPicker Institute, Inc.
Principal investigator: Richard M. Wardrop III, MD, PhD, FAAP, FACP, WakeMed Faculty Physicians, Internal Medicine and Pediatrics, Assistant Professor at Virginia Tech Cailion School of Medicine and the University of North Carolina School of Medicine
The Resident Performance project intended to adapt an existing attendant-based evaluation into a patient-centered prototype tool that is concise, valid and reliable, and that enables patients to accurately assess resident performance on 4/6 ACGME competencies. Performance with regard to ACGME core competencies of residents who receive feedback and coaching using the patient-centered tool was compared to that of those who received attending-only feedback.
evidence based practice that hlps in you reasarch and ease you in reaseach practice. in this presentation many things are given which you learn n your research article.
Leveraging Patient Support Programs in Biologic-Biosimilar Competitive LandscapeAlex Xiaoguang Zhu
Biologics are facing intense competition from biosimilars. In this competitive landscape, strategic levers for both branded biologics and biosimilars typically include payor strategy, promotion and new formulation. As patients become more engaged and patient-centricity is on the rise, there is an increased opportunity to leverage patient support programs as additional strategic lever. This presentation will cover five key learnings that we have uncovered while conducting multi-phase patient support program research for both branded biologics and biosimilars.
Evidence based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients/clients.
Integration of the best research evidence with clinical expertise and patient values and using the best available research findings “to make clinical decisions that are most effective and beneficial for patients.
- It is a movement away from always doing things in the way in which we were taught and from decisions based on personal opinion. It requires that we look for and appraise research evidence to inform decisions about tests, treatments, patterns of practice, and policy.
Ask Converting information needs into clear questions
Acquire Seeking evidence to answer those questions
Appraise Evaluate the evidence for its validity and usefulness.
Apply Integrating findings with clinical expertise, patient needs, applying the finding.
Assess Evaluating performance.
EBP is a systemic interconnecting of scientifically generated evidence with the tacit knowledge of the expert practitioner to achieve a change in a particular practice for the benefit of a well-defined client/ patient group.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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2. What is Pain?
An "unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage.“
-The International Association for the
Study of Pain
http://health.howstuffworks.com/diseases-conditions/pai
3. Types of Pain
Acute or Transient pain
Chronic or Persistent Pain
Cancer Pain
http://health.howstuffworks.com/diseases-conditions/headache/10-
types-of-headaches.htm
4. Methods of Managing Pain
• Internal Procedures
• Medication
• Therapy
• Alternative
Therapies
• Counseling and
Support
Acupuncture is a common
alternative method for relieving pain
http://health.howstuffworks.com/wellness/natural-medicine/chinese/acupuncture.htm
5. Measuring Pain
“Pain is whatever the experiencing patient says it is,
existing when she/he says it does” –McCaffery and
Pasero (1999)
Patient’s Perspective:
◦ Demands physical, emotional, and mental
energy
Provider’s Perspective:
◦ Assessed by looking at a patient’s report, not
the predicted signs and symptoms
◦ Patients tells if pain is present and what it is
like
9. Effective Pain Management and
Considerations
Understand a patient’s cultural
differences in pain expression
◦ Different cultures may have different ideas
of the meaning of pain
Assess the meaning of pain to a
patient
11. OPQRSTU of Pain
Assessment
O nset
P rovocative/Palliative Factors
Q uality (Open Ended Questions)
R egion/Radiation
S everity
Timing
U You
“How does pain affect you?”
17. Using Pain Scales to Make
Decisions about Pain Medication
Pain Scales make the pain
measurable
Helps to determine if pain is mild,
moderate, or severe
Makes it easier to find an effective
dose
18. Factors Considered when
Determining Medication Dosage
• History of a patient’s pain
• Pain intensity
• Duration of Pain
• Aggravating and Relieving Conditions
• Determine the cause of the pain
19. Clinical Simulation-Based
Training
“Simulation is a technique – not a technology –
to replace or amplify real experiences with
guided experiences that evoke or replicate
substantial aspects of the real world in a fully
interactive manner.” – David M. Gaba, Stanford
University
Examples:
◦ Standardized Patients
◦ Mannequins
◦ Computer-Based Simulation Used to build a safer health
system by providing guided
practice
http://blog.hospitalclinic.org/en/2009/05/nou-laboratori-de-simulacio-
clinica-de-la-facultat-de-medicina/
20. Benefits of Clinical Simulation
http://www.temple.edu/ics/programs/medicine/fy2.html
• Provides a variety of real-life situations
• Opportunity to repeatedly practice without
real patients
• Convenient
• Active learning and Concentration
• Increases collaboration within medical
teams
21. Standardized Patient
•An actor trained to portray the role of a
patient, family member, or another
individual
•Simulate in a standardized manner
http://www.temple.edu/ics/about/standardized.ht
ml
http://www.hopkinsmedicine.org/simulation_center/training/standardized_patient_program/index.
html
22. Resident Problems with Opioid
Decision Making
Lack of Confidence
Poor Interviewing Technique
Lack of Opioid Knowledge
Poor written orders for medication
Inconsistent use of drug calculations
to determine drug doses
23. Improving Opioid Decision
Making with Clinical Simulation-
Based Training
Goals:
◦ To improve physician confidence when
working with a patient experiencing pain
◦ To use drug calculations when making
opioid decisions
◦ To write appropriate orders
http://zotzine.uci.edu/2009_04/patient.php
24. Assessing a Patient with Pain
• Describe the Pain Scale Appropriately
• Ask patient of history of addiction
• Discuss addiction vs. dependence
• Ask about opioid related side effects
• Assess for constipation
• Address the fear of addiction
• Make correct doses
25. Results
More comfortable with making
dosage decisions
Increase in confidence
http://blog.soliant.com/doctor-and-physician-salary-
ranges-average-salaries-and-educational-
requirements/
More frequent use of opioid conversions
Not much effect on writing appropriate
orders
26. Improving Results in the
Future
Continuous education and regular
review will continue to improve
resident physician skills
http://www.thedoctorweighsin.com/%E2%80%9Ctake-this-medication-okay-taking-a-look-at-emergency-department-discharge-instructions/
27. Acknowledgements
I would like to thank Ms. Emily Shaw,
Ms. Kat Walker, and all of the other
staff at the Simulation Center for
helping to make this project possible